Healthcare Provider Details

I. General information

NPI: 1801790951
Provider Name (Legal Business Name): RED OAK SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PRENTISS LN
BELMONT MA
02478-2021
US

IV. Provider business mailing address

20 PRENTISS LN
BELMONT MA
02478-2021
US

V. Phone/Fax

Practice location:
  • Phone: 201-600-2058
  • Fax:
Mailing address:
  • Phone: 201-600-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENICA GRAHAM PHELPS
Title or Position: SOCIAL WORKER
Credential: LICSW
Phone: 201-600-2058